白蛋白联合醋酸钠林格注射液作为置换液在儿童血浆置换治疗中的安全性观察  

Safety of albumin combined with acetate Ringer’s solution as replacement fluid in therapeutic plasma exchange of pediatrics

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作  者:钱亚莉 范铭兴 缪红军[1] 葛许华[1] QIAN Yali;FAN Mingxing;MIAO Hongjun;GE Xuhua(Emergency Department/Intensive Care Unit,the Affiliated Children’s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区:[1]南京医科大学附属儿童医院急诊/重症医学科,江苏南京210008

出  处:《南京医科大学学报(自然科学版)》2023年第11期1550-1556,共7页Journal of Nanjing Medical University(Natural Sciences)

基  金:国家自然科学基金(82170733)。

摘  要:目的:观察白蛋白联合醋酸钠林格注射液作为置换液在儿童患者中行治疗性血浆置换(therapeutic plasma ex-change,TPE)的安全性。方法:纳入2019年4月—2023年3月南京医科大学附属儿童医院儿科重症监护病房因病需要进行TPE的患儿共20例,按随机数字表法分为观察组10例和对照组10例。观察组的置换液使用20%人血白蛋白联合醋酸钠林格注射液(按照1∶5的比例配制),对照组的置换液使用新鲜冰冻血浆。比较两组治疗过程中血流动力学指标及不良事件的发生,治疗结束后1周凝血指标、生化指标及基础疾病情况,两组治疗前后的凝血指标、生化指标。结果:治疗过程中两组平均动脉压及心率稳定,差异无统计学意义(P>0.05)。观察组的总蛋白(total protein,TP)、球蛋白(globulin,GLB)、纤维蛋白原(fibrinogen,Fbg)、血磷(P)、血钙(Ca^(2+))较治疗前下降,差异有统计学意义(P<0.05)。对照组的白蛋白(albumin,ALB)、国际标准化比值(international normalized ratio,INR)、凝血酶原时间(prothrombin time,PT)、P、Ca^(2+)、血镁(Mg^(2+))较治疗前下降,差异有统计学意义(P<0.05);两组治疗后变态反应及低钙血症发生率差异无统计学意义(P>0.05)。两组治疗结束后1周的凝血指标、生化指标及基础疾病情况差异无统计学意义(P>0.05)。结论:在儿科患者中应用20%白蛋白联合醋酸钠林格注射液(1∶5)作为置换液行TPE是安全的,可有效节约血液资源,但治疗过程中需监测患儿凝血及生化相关指标,及时补充新鲜冰冻血浆等血制品纠正凝血功能。Objective:To investigate the safety of albumin combined with acetate Ringer’s solution in therapeutic plasma exchange(TPE)of pediatrics.Methods:A total of 20 patients with diseases requiring TPE from April 2019 to March 2023 in the intensive care unit of the Affiliated Children’s Hospital of Nanjing Medical University were included,and were randomly divided into an observation group and a control group.The observation group chose 20%albumin combined with acetate Ringer’s solution in the ratio of 1∶5 as the replacement fluid,and the control group chose fresh frozen plasma as the replacement fluid for TPE.The hemodynamic indexes,the occurrence of complications during treatment,the coagulation indexes,biochemical indexes and the response of the underlying disease 1 week after the end of treatment between the 2 groups of patients were compared.The coagulation indexes and biochemical indexes were compared within groups before and after TPE.Results:Mean arterial pressure and heart rate were stable in both groups during treatment without significant differences(P>0.05).Total protein(TP),globulin(GLB),fibrinogen(Fbg),serum phosphorus(P)and serum calcium(Ca^(2+))decreased after treatment compared with those before treatment in the observation group,and the differences were statistically significant(P<0.05).Albumin(ALB),international normalized ratio(INR),prothrombin time(PT),P,Ca^(2+)and serum magnesium(Mg^(2+))decreased after treatment compared with those before treatment in the control group,and the differences were statistically significant(P<0.05).The incidences of allergic metaplasia and hypocalcemia between the two groups after treatment were not statistically significant(P>0.05).The coagulation indexes,biochemical indexes and the response of the underlying disease 1 week after the end of treatment between two groups were not statistically significant(P>0.05).Conclusion:It is safe to apply 20%albumin combined with acetate Ringer’s solution(1∶5)as the replacement fluid in TPE of pediatric patients and can

关 键 词:白蛋白 醋酸钠林格注射液 血浆置换 安全性 儿童 

分 类 号:R726.1[医药卫生—儿科]

 

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